Emotional Issues and Bathroom Problems

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Emotional causes of bathroom-related problems are among the most challenging to address, since young children are rarely able to express their confusion, anxiety, or fear in words. Such behaviors as defecating in a corner of the bedroom, having daily accidents at school after many months of complete dryness, or pleading to return to diapers are disturbing and even frightening to many parents—more so when they do not understand the cause. Once physical causes have been ruled out, however, the reasons behind many of these behaviors can be unearthed by considering any changes in your child’s life or emotional development, observing her other behaviors, and listening carefully to what she says.

Major change in a child's life can cause her to regress during toilet training. Regression can occur for similar reasons long after toilet training has been accomplished. A new baby in the family, a move to a new house, family conflict, or any other emotionally stressful situation may cause your child to revert to an earlier level of bathroom mastery—possibly involving bedwetting, puddling, withholding of stool, and even defecating in inappropriate places. Inner stress prompted by your child’s normal development can affect her bathroom behaviors as well.

At about three years of age, for example, children begin to develop the capacity to experience discomfort, or shame, when they have done something they know is wrong—yet most children this age do not know what to do with these feelings. A child who longs for her parents’ approval may suddenly start to feel embarrassed or ashamed when a bathroom accident occurs, no matter how accepting her parents are actually likely to be. As a result, she may claim to have used the bathroom when she really urinated on the living room floor. She may hide her wet underwear, or even try to clean up the mess before you see it.

There is certainly no cause to criticize or punish a child who behaves in this way. On the contrary, she has demonstrated that she knows what proper bathroom behavior is and is trying as best she can to make it “come true.” The best response when you find your child hiding her accidents from you is to gently tell her that you know she had an accident, that it’s okay, and that you know she will do better next time. Then ask her to help you clean up, and talk with her about specific ways in which the two of you can help her get back on track.

Other feelings and emotional situations can overwhelm your young child and cause her to behave in ways that are initially puzzling. A desire for more attention may cause her to stage an increasing number of accidents just to engage you in conversation or emotional interaction. If she feels you have been too controlling about bathroom use—constantly asking her if she needs to go instead of letting her direct her own behavior—she may resist going until it’s too late and she has an accident instead. A more active imagination and a tendency toward magical thinking may cause her to fear the toilet and start to avoid it. Even a desire to befriend another child by imitating him can lead to regressive bathroom practices if the other child has not been toilet-trained. Finally, a temporary wish to return to coddled babyhood, which nearly all young children experience at some time, may prompt your child to ask you if she can start wearing diapers again.

For toilet-trained children, as well as for those still being trained, regression in bathroom use usually does not last long if parents respond calmly and use it as an opportunity to support and communicate with their child.

You can help your child identify the problem, sympathizing with her feelings, helping her find practical solutions, and clarifying your expectations regarding toilet use. Such evidence of your support and understanding will help her to relax and eventually move forward.

Meanwhile, try to avoid major, concrete concessions such as returning to diapers, but offer to put her in training pants under panties for a while, place the potty in her room, accompany her to the preschool bathroom before the school day begins, or otherwise compromise until she feels more secure.

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.